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How the US Became the Most Dangerous Place For a Home Birth

Photograph by Twenty20

According to the latest statistics, about 1 percent of U.S. births each year—or 35,000— take place at home. That number may be on the rise, but the American College of Obstetrics and Gynecology says women should be informed of the pros and cons before going forward.

Specifically, while planned home births have a lower risk of interventions (like C-sections), they also come with an increased risk of infant death and complications. The official recommendation from ACOG? The hospital is still safer than home.

But in other countries, home birth can be just as safe as hospital birth, reports Smithsonian Magazine. The reason the U.S. lags behind in home-birth safety is because it’s not part of our medical system the way it is in Canada or the Netherlands, where midwives are trained extensively both in and out of hospitals, and strict protocols are in place should an emergency occur.

Here in the U.S., we have certified nurse midwives, or CNMs,. who receive training that exceeds the standards set by the International Confederation of Midwives. But there are also certified professional midwives, or CPMs, who don’t meet those same standards.

A 2010 study of midwives found that home births attended by certified professional midwives had four times the neonatal mortality rate of hospital births.

And the difference in training shows: A 2010 study of midwives found that home births attended by certified professional midwives had four times the neonatal mortality rate of hospital births. Those attended by certified nurse midwives still had a slight increased mortality rate, but not nearly as dramatic. Although these professional midwives (as opposed to nurse midwives) are only legal in 28 states, they attend the majority of American home births, often practicing outside the law.

Training isn’t the only issue, according to the Smithsonian article. In Canada, midwifery is more widely accepted by the medical community, while also being more strictly regulated so that women with serious conditions or potentially complicated labors are not allowed to give birth at home.

So can American women opting for a home birth ever expect to receive the same care and support that women elsewhere receive? Unfortunately, ACOG weighs in once again, saying that the positive results associated with midwifery in other countries may not be possible in the United States, where “integrated services between midwives, doctors and hospitals are lacking.”

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